Tthe presented, small, female patient was a newborn. There was an obvious macrosomy with diabetes mellitus of the mother. Birth by caesarean section. In the obviously thickened layer of fat of the subcutis, many, well-sliding lesions were palpable. In the ultrasound examination, these were already polymorphic, cystic stuctures. The indication for MRI was made to ensure no communication of the lesions to the intraspinal structures.

Pathomorphology or Pathophysiology of this disease :

Lymphangiomas are mesenchymal masses, which can contain fat, fibrotic tissue and smooth muscle. The etiology is unknown. Aside from an anomaly of the lymphatic system or a congenital obstruction of the lymphatic drainage system, lymphangiomas are partially characterized as neoplasias. A progressive growth has been described. Capillary, cavernous and cystic lymphangiomas have been distinguished. The masses are often found in the area of the neck or axilla in children.

Radiological findings:

MRI 1: T2 - Sagittal

MRI 2: T1 - Sagittal

MRI 3: T1 - Transversal

MRI 4: T1 - Transversal - with contrast

MRI 5: T2 - Transversal

Proof of multiple, partially merging lesions in the midline, or paramedially on the right side in the area of the back in the subcutical fat tissue. Strong signal in T2-weighted images, hypointense representation in T1-weighted images. After administration of contrast media, proof of a bone marrow uptake in the edges of the lesions. Partial proof of septations.

Diagnosis confirmation:

Total constellation (Consens)

Which DD would be also possible with the radiological findings:

Only a few lesions can be included. In adulthood, lipoblastomas should be considered. A hemangioma/hemangioblastoma is usually discarded through imaging findings. In our small patient, we had to consider dysraphias due to the localization.

Course / Prognosis / Frequency / Other :

The prognosis is good. A malignant transformation is not known. In structural relation to important organ structures can, however, lead to serious clinical symptoms due to the compressing nature of lymphangiomas (i.e. mediastinal tumors ==> dyspnea). Treatment of choice is surgical, reoccurances are, however, common.

Comments of the author about the case:

There are flowing transitions between the cystic and cavernous lymphangioma. I would like to discuss these findings.